Complete linear lesions in the left atrium using conventional radiofrequency were difficult to achieve but were associated with stable sinus rhythm in 74% of patients during long-term follow-up.
Cohort (n=84)
Does the design of catheter-induced linear lesions affect procedural completeness and long-term stable sinus rhythm in patients with drug-refractory atrial fibrillation?
Complete linear lesions in the left atrium using conventional radiofrequency are difficult to achieve but are associated with a high rate of stable sinus rhythm in patients with drug-refractory atrial fibrillation.
OBJECTIVES: In this study using radiofrequency current and the electroanatomic mapping system CARTO, four line designs were tested in 84 patients suffering from drug-refractory atrial fibrillation (AFib). BACKGROUND: Prevention of AFib by trigger elimination within the pulmonary veins (PVs) has been recently reported, but the success may be lesser in patients with chronic AFib or large atria requiring linear lesion deployment. METHODS: Type A encircled the ostia of all four PVs with a connection to the mitral annulus (MA). In type B, three lines connected anatomic barriers. Type C encircled both septal and lateral PVs with connections between PVs and to the MA. Type D encircled PVs only. In the initial 12 patients (type D/1), line validation was performed without, and in 23 patients (type D/2) with, an additional catheter inside the encircled PVs. RESULTS: The ability to achieve completeness of all intended lines was 5% in type A, 21% in type B, 29% in C, 66% in type D/1, and 61% in type D/2. This resulted in stable sinus rhythm in 19% (4/21 patients) in type A, 32% (6/19 patients) in type B, 50% (7/14 patients) in type C, 58% (7/12 patients) in type D/1, and 65% (15/23 patients) in type D/2, respectively, over a mean follow-up of 620 +/- 376 days. Besides thromboembolic events (one stroke and one transient ischemic attack), total occlusion of a PV was a major complication in one patient, and acute tamponade in two patients. CONCLUSIONS: Complete lesions in the left atrium were difficult to achieve using conventional radiofrequency current technology, but were associated with sinus rhythm in 74% of patients during long-term follow-up, whereas incomplete lesions led mostly to recurrences of AFib or gap-related atrial tachycardia.
Ernst et al. (2003) conducted a cohort in drug-refractory atrial fibrillation (n=84). Catheter-induced linear lesions using radiofrequency current and CARTO was evaluated on Stable sinus rhythm. Complete linear lesions in the left atrium using conventional radiofrequency were difficult to achieve but were associated with stable sinus rhythm in 74% of patients during long-term follow-up.